Natural History of Renal Cortical Neoplasms During Active Surveillance With Follow-up Longer Than 5 Years

• Published in: Urology (Ridgewood, N.J.) N.J.), 2011-04, Vol.77 (4), p.787-791
• Main Authors: Haramis, Georgios, Mues, Adam C, Rosales, Juan Carlos, Okhunov, Zhamshid, Lanzac, Alberto Perez, Badani, Ketan, Gupta, Mantu, Benson, Mitchell C, McKiernan, James, Landman, Jaime
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Carcinoma, Renal Cell - pathology; Carcinoma, Renal Cell - therapy; Cryosurgery; Female; Humans; Kidney Cortex; Kidney Neoplasms - pathology; Kidney Neoplasms - therapy; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Retrospective Studies; Urology; Watchful Waiting
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2010.09.031

Objectives To present our experience with patients who elected active surveillance for renal cortical neoplasms (RCNs) with ≥5 years of follow-up. Few data are available regarding the long-term natural history of RCNs during surveillance. Methods We retrospectively reviewed our urologic oncology database and identified 44 patients with 51 RCNs who had received active surveillance for >5 years of follow-up. The patient and tumor characteristics and tumor growth rate and overall survival data were evaluated. Results The median patient age was 71.7 years (range 55-92), with 32 patients (72.7%) having a Charlson comorbidity index of ≥2. The median tumor size was 2.67 cm (range 0.9-8.6) at diagnosis. Biopsy was performed in 17 patients (38.6%). Of these 17 patients, clear cell renal cell carcinoma was diagnosed in 15 and papillary renal cell carcinoma in 2 patients. The median follow-up was 77.1 months (range 60-137), and the median growth rate was 0.15 cm/y. Of these patients, 2 (4.5%) required delayed intervention. One underwent laparoscopic radical nephrectomy because of a high tumor growth rate, and one elected to withdraw from active surveillance because of personal anxiety, despite having a stable tumor size for 72 months. The latter patient underwent laparoscopic renal cryoablation. Histopathologic examination revealed clear cell renal cell carcinoma in both cases. No metastases or cancer-related deaths occurred in our cohort; 1 patient died of cardiovascular disease. Conclusions Most RCNs undergoing surveillance for >5 years grew slowly. The metastatic potential appeared minimal in patients who demonstrated low or absent tumor growth for a long period.